Drilling/milling guide and keel cut preparation system
An instrument system, associated milling or drilling guide and method include use of a trial implant of a size corresponding to an actual implant for the intervertebral space, with a milling guide mounted on the trial implant. The system also includes a cutting tool which is used to form a cutout in an adjacent vertebra.
1. A method for preparing an intervertebral space for receiving an implant, comprising the steps of:
placing a head of a trial implant into the intervertebral space such that a first surface of the head faces a first vertebral body and a second surface of the head, spaced from the first surface along a first direction, faces a second vertebral body;
supporting a milling guide having a milling guide body relative to the trial implant such that a distal end of the milling guide body is spaced from a proximal end of the milling guide body along a distal direction, perpendicular to the first direction, and such that a pivot element of the milling guide that is coupled to the milling guide body at a pivot axis is elongate along the distal direction;
inserting a cutting tool into a channel that extends through the pivot element; and
moving the cutting tool in a sweeping motion in a plane that extends along the first and distal directions by pivoting the pivot element about the pivot axis relative to the milling guide body so as to form a cutout in one of the first and second vertebral bodies.
2. The method of claim 1 , wherein the moving step comprises moving the cutting tool in a sweeping motion without translating the pivot element relative to the milling guide body with respect to the distal direction.
3. The method of claim 1 , wherein the moving step comprises rotating the cutting tool so as to form the cutout.
4. The method of claim 1 , wherein the moving step comprises moving the cutting tool in the sweeping motion into a longitudinal groove defined in one of the first and second surfaces of the head.
5. The method of claim 1 , wherein the inserting step comprises inserting the cutting tool into the channel until a stop of the cutting tool abuts the milling guide so as to limit insertion depth of the cutting tool.
6. The method of claim 1 , wherein the pivot element has a proximal end and a distal end spaced from the proximal end along the distal direction, and the pivot element is pivotally coupled to the milling guide body at the proximal end of the pivot element.
7. The method of claim 1 , wherein the supporting step comprises coupling the milling guide body to a body of the trial implant that extends from the head of the trial implant along a proximal direction, opposite the distal direction.
8. The method of claim 7 , wherein the supporting step comprises sliding the milling guide body over the body of the trial implant.
9. The method of claim 7 , wherein the supporting step comprises receiving the body of the trial implant into the milling guide body.
10. The method of claim 1 , wherein the pivot axis extends through both the milling guide body and the channel in a second direction that is substantially perpendicular to the first direction and the distal direction.
11. The method of claim 10 , wherein pivot element is coupled to the milling guide body by a pin that extends from the milling guide body to the pivot element in the second direction along the pivot axis.
12. The method of claim 1 , comprising, before the placing step, inserting at least one other trial implant into the intervertebral space, determining that the at least one other trial implant is an incorrect size, and removing the at least one other trial implant.
13. The method of claim 1 , wherein the inserting step comprises cutting into the one of the first and second vertebral bodies as the cutting tool advances through the channel along the distal direction.
14. The method of claim 1 , wherein the supporting step comprises supporting the milling guide such that a chamber of the milling guide is elongate along the distal direction and is spaced from the pivot element along the first direction.
15. The method of claim 1 , wherein the supporting step comprises supporting the milling guide such that the pivot element is disposed at a first end of the milling guide body, and a chamber of the milling guide is positioned at a second end of the milling guide body, spaced from the first end along the first direction, the chamber being elongate along the distal direction.